1. Mr Speaker, I thank the Members for the robust debate and support for the Social Residential Homes Bill. Let me now respond to the Members’ questions and suggestions.
2. Firstly, on measures to ensure residents’ safety and well-being.
3. Mr Yip Hon Weng asked why MSF does not stipulate minimum staffing ratios for Homes in the Bill. Today, all Homes funded by MSF, which includes most Homes licensed under the existing Homes for the Aged Act and Children and Young Persons Act, need to abide by minimum staffing ratios set out by MSF. This Bill will allow MSF to set out minimum staffing ratios for all licensed Homes.
4. Mr Melvin Yong also asked about the evolution of sector standards over the years. As mentioned in my Opening Speech, we have enhanced our care models. In addition to Children’s Homes, Adult Disability Homes, Sheltered Homes and Welfare Homes have also adopted a tiered approach, to provide more intensive care and targeted support to residents with higher care needs. As the sector continues to grow, our standards of care will also evolve to meet changing needs.
Mandatory suitability assessment
5. Mr Louis Ng asked about the types of duties carried out by individuals who require MSF’s approval prior to deployment in the Home. Broadly, these duties would include:
a. First, those relating to the overall governance, leadership and management of the Home, such as management of the Home’s financial accounts. We want to be sure that any individual who takes on any leadership or management responsibilities, such as key appointment holders and person-in-charge, is of good standing.
b. Second, those involving direct unsupervised contact with residents, such as helping residents who are less mobile with their personal hygiene and meals. This is so that we do not place vulnerable residents at undue risk of harm through exposure to individuals with a record of egregious offences.
6. Mr Ng also asked how long the pre-approval would take, and also, support for Homes with recruitment planning. Generally, we endeavour to inform Homes of the outcome of the assessment within 2 weeks. Concurrently, MSF is reviewing ways to complete the process even faster, including through streamlining or automating some parts of the suitability assessment processes.
7. Ms Ng Ling Ling asked about the accuracy of background checks on foreign staff. Under this Bill, all prospective foreign staff in licensed Homes will be required to submit a self-declaration if they had committed any offence in any country, as specified by the Ministry of Manpower. If we find out that a false declaration had been made, the individual may be liable to regulatory actions under the Bill, such as cancellation of approval to work in the Home, and/or prosecution under the Penal Code.
Use of force
8. Mr Yong asked about the number of cases of Home staff that were investigated and taken to task for excessive use of force. Such cases are fortunately uncommon. Over the 2020-2024 period, MSF received an average of 6 reports per year on resident abuse, including that of excessive use of force. Several were not substantiated and where substantiated, staff were taken to task. MSF adopts a zero-tolerance approach towards the use of excessive force on our residents and will thoroughly investigate these allegations.
Public inspection system
9. Mr Yip suggested creating a public rating system for Homes, so that family members and the public will be made aware if a Home is performing poorly. To address the Member’s underlying concern on accountability, MSF works closely with Homes in the case of incidents, to ensure that residents and their family members are aware of the situation, what is being done to address the concerns, and to involve them in decisions regarding their care arrangements where possible. We will consider practices in other countries to strengthen public accountability. The goal should be to help the Homes enhance their performance and accountability, and create a culture of continual improvement.
10. Mr Yip and Mr Yong would also be assured to know that we have multiple channels in place for residents and family members to provide feedback on Homes. A Board of Visitors, or BOV, consisting of independent members of the community, such as private and social sector professionals, will visit Homes at least once a quarter. The BOV may also visit certain Homes more frequently, if there is a need to monitor them more closely. These visits are unannounced, to enable the BOV to check on residents’ living conditions and speak with residents to hear any concerns they may have.
11. Residents and their family members may also provide their feedback to MSF via our hotline or email. Through these channels, we can promptly address concerns, and foster greater accountability from Homes.
Shortfalls in Homes
12. Mr Dennis Tan asked if there were any shortfalls or uneven standards of care across the Homes. As mentioned in my Opening Speech earlier, MSF introduced this Bill to codify the good progress that has been made in raising the quality of care over the years. It is not in response to uneven standards of care, or any incidents of a serious nature.
Scope of the Bill
13. Mr Yong raised a few questions on the Singapore Boys’ Home and Singapore Girls’ Home. In particular, (i) the reasons for excluding them from this Bill, (ii) whether these Homes are subjected to the same standards in this Bill, and (iii) who is responsible for ensuring the quality of care in these Homes.
a. The Singapore Boys’ Home and the Singapore Girls’ Home are operated by the Government, and are excluded from the licensing regime under this Bill. However, this does not mean that they do not need to meet the standards of care. In fact, they are held to the same standards, if not higher.
b. To ensure good quality care is provided in the Singapore Boys’ Home and Singapore Girls’ Home, these Homes are subjected to independent inspections, as well as regular visits by a Review Board. Similar to the BOV, the Review Board comprises independent members of the community, who review the living standards and standards of care in these Homes.
14. Next, I will address the queries raised on the enforcement framework against errant operators.
Step-in powers
15. Mr Ng and Mr Yip asked if MSF will have a framework to decide when the step-in powers will be exercised, and which arrangements will be ordered. The answer to this is yes. In determining when and how to exercise the step-in powers, MSF will thoroughly assess the facts of each case, such as the severity of harm caused to residents. I wish to emphasise that these step-in powers are meant to be a measure of last resort, after all other avenues are exhausted. Accordingly, the use of step-in powers will cease once the operations of the affected Home have stabilised, and we are assured of residents’ safety and well-being.
16. Mr Yong asked about the number of Homes that have required a change of operators in the past ten years. Thus far, only one Home underwent a change of operator, as the operator had decided not to continue running the Home following a thorough evaluation of the organisation’s resources and strategic direction. MSF, the affected Home, as well as the incoming Home operator worked closely to ensure a smooth transition for staff and continuity of care for residents.
17. Mr Ng and Mr Yong also asked how MSF would prepare other licensed Homes to take over the operations or residents of a failing Home. MSF will work closely with both the incoming and outgoing operators to facilitate the handover processes, including the care arrangements for residents during the step-in period. We will also ensure that capacity is sufficient. Our priority is to ensure that the continuity of care for residents in the affected Home is assured.
18. To be clear, activating another licensed Home to step-in is only one option that MSF may take under step-in powers. Other options include appointing a third-party to advise the licensee on the Home’s operations or revoking the appointment of an existing Key Appointment Holder, and reappointing another individual to take over the responsibilities.
Whistleblowing and Protection for Whistleblowers
19. Mr Ng asked whether whistleblowing protections under clause 53 apply to individuals who report offences under the Bill to the Police. The whistleblower will be referred to the MSF inspecting officers to assist investigation of the offence, and will be conferred protection under clause 53.
20. Mr Yip asked if whistleblowers would be constrained in reporting poor living or care conditions because of the restriction on publishing information about residents. The answer is no. Clause 38 protects the identities of residents in these Homes from being published or broadcasted. Whistleblowers come to MSF to share information privately, rather than broadcast identifiable details of clients in the public sphere. In addition, under clause 53(2) of the Bill (on whistleblowing), a person who whistle-blows to MSF in good faith cannot be held in any legal proceedings with respect to any restriction on disclosure imposed by any rule of law. Such a provision was included in our Bill precisely to encourage whistleblowers to step forward if they have such concerns.
Regulatory actions
21. Ms Ng raised several questions on (i) the level of approval for Codes of Practice, (ii) calibration of penalties for breaches of Codes of Practice, and (iii) the lines of accountability for regulatory breaches.
a. First, the Codes of Practice that are issued to Homes are approved by the Director-General.
b. Second, the type of regulatory action taken will be calibrated, depending on factors such as degree of harm caused, and if it is a repeat breach by the Home. In some cases, we may suspend approval of specific individuals working in the Home; in others, we may shorten a Home’s licence while giving the Home guidance on issues that need to be rectified.
c. Third, in deciding who to take regulatory actions on, please be assured that we have every intention to be fair and reasonable, and we will not be overly punitive to our stakeholders.
i. Allow me to illustrate with a hypothetical example. We intend to introduce a regulatory requirement on the licensee to ensure that staff are adequately trained. If a staff member of the Home fails to meet the minimum first aid training requirements and is thus unable to promptly attend to residents’ need for first aid, we may take action against the licensee.
Criminal Penalties
22. Mr Yong expressed concern that the enhanced penalties may be excessive and could inadvertently discourage operators or staff from joining the sector.
a. The penalties under this Bill, are commensurate with that of comparable offences under other legislation.
b. One notable example is the Healthcare Services Act, which licenses the provision of nursing home service. Much like our Homes, residents in nursing homes are vulnerable and reliant on the Home for 24/7 care. The safety and well-being of our Homes’ residents are no less important.
c. We recognise that some Homes may be anxious about the enhanced penalties. To provide the various stakeholder groups, such as Board Members, with greater clarity over their duties, we will set out their roles and responsibilities in the Subsidiary Legislation and Codes of Practice.
d. We will not be punitive from the outset. Instead, we will work closely with Homes to ensure that they are well-supported to meet the regulatory requirements under this Bill.
23. Next, I will move on to questions and suggestions pertaining to capability building for our Homes.
Funding support
24. Mr Yong and Mr Tan asked about the regulatory costs arising from this Bill, and the support to Homes to transit to the new licensing regime. We do not expect the regulatory costs to be significantly higher than today, as the requirements build upon existing legislation and service requirements that Homes are familiar with.
25. Nonetheless, MSF and the National Council of Social Service (NCSS) have set aside a $33 million Transition Support Package for all licensable Homes. Mr Tan will be pleased to know that with this funding, Homes will be able to invest in (i) training for staff, (ii) updating or installing CCTV systems, and (iii) change management efforts, as they transit to this new licensing regime. Funding will be customised based on the needs of each Home.
26. In addition to the one-off Transition Support Package, Ms Ng and Mr Yong suggested setting up a long-term capability building fund, to support Homes in building up their operational capabilities and staff competencies. Investing in sector capabilities is one of our key priorities, and we have several schemes and grants available to help SSAs level up.
a. NCSS administers the Transformation Sustainability Scheme that provides funding to SSAs to enhance their strategic and organisational capabilities. With this funding, SSAs are supported in (i) improving staff retention, (ii) strengthening volunteer engagement, and thereafter, (iii) successfully delivering on other capability-building projects.
b. The Charities Capabilities Fund, or formerly known as the VWO-Capability Fund that Ms Ng mentioned, continues to be available to SSAs. It covers a range of capability building matters, including governance and management training for charities’ board members and staff.
27. Ms Ng suggested exploring bulk procurement of common equipment to optimise public funds and resources available to the Homes. We thank her for the suggestion; MSF and NCSS will work with SSAs to optimise resource utilisation, and adopt solutions that would best meet their needs.
(Foreign) Manpower and Salaries
28. Mr Yip and Mr Yong asked if staff in our Homes are paid fairly, and are sufficiently supported to ensure that they do not burn out while caring for our residents. Mr Tan asked a related question about how we intend to support Homes’ manpower needs. We are invested in the manpower sustainability of this sector. In my Opening Speech, I shared about our reviews of the Skills and Salary Guidelines to ensure that staff are paid competitively, and about NCSS working closely with SSAs to develop stronger organisational capabilities and a supportive workplace environment.
29. To attract and retain talent in the sector, MSF has also embarked on a job redesign pilot with selected Homes. Through this pilot, we hope to enhance the value proposition of a career in the sector – specifically, by improving the working conditions and supporting the career development of care staff.
30. Mr Yip also asked about the support that MSF provides to ensure that Homes have sufficient trained caregivers, including those from foreign countries, and whether foreign worker ratios need to be relaxed. To this end, MSF will continue to work with MOM to ensure that Homes have sufficient work pass quota and flexibility to recruit foreign care staff, whilst also ensuring opportunities for local staff to progress in their careers.
Longer-term plans for the sector
31. Mr Yip spoke about the need for adequate capacity. MSF keeps a close eye on the demand and supply of the capacity of our Homes. For Adult Disability Homes, which includes Adult Disability Hostels, we are actively addressing waitlist management through several initiatives. We are expanding capacity by adding new facilities and are optimising placement processes to ensure cases with urgent needs are prioritised. Additionally, we are strengthening community-based support services to provide alternatives to residential care where appropriate. One example is the Enabled Living Programme pilot, which is an alternative to residential care and seeks to enable persons with disabilities to live and age in the community.
32. We will continue to ensure sufficient capacity to meet projected demand over the long-term, an issue that Mr Yong also spoke about. As caregivers age and with shrinking family sizes, we expect a slight increase in demand over the next decade. At the same time, MSF and MOH are ramping up our support for persons with disabilities and seniors to age-in-place, and for those in Homes to be reintegrated more quickly back to the community, so that fewer of them need to stay in institutional care. With the slight increase in demand, manpower needs will also increase. We will continue to invest in technology and process redesign, to enhance workforce productivity.
33. Relatedly, Mr Yip noted that the Bill empowers the Director-General to set capacity limits on Homes, and expressed concern that this could lead to turning residents in need away. To be clear, the key objective of setting capacity limits is to ensure that quality care can be provided to residents. These limits are determined based on practical considerations, which include: (i) physical space requirements, (ii) infrastructure capabilities, and (iii) staffing ratios. As I had mentioned earlier, MSF will continue to monitor demand and supply trends to ensure sufficient capacity.
34. Mr Tan asked why the Bill would need to provide for the possibility of housing different client profiles together. Let me share an example. Some seniors may have acquired disability while some persons with disabilities have aged and have become seniors themselves, so we may need to equip our Homes to cater to both types of needs.
35. We are in the early stages of reviewing how the sector can evolve over the longer-term, to improve care quality, leverage technology and build capabilities for better client outcomes. We will work closely with the sector to co-create the future of social residential homes.
Call to Action for BOV Volunteers
36. Earlier, Ms Ng expressed her appreciation to individuals who have readily volunteered to be members of the BOV. I echo Ms Ng’s appreciation for BOV volunteers, and would like to share the example of one such volunteer, Ms Sharifah Masturah Shahab-Yokoyama. She is a veteran special educator, with over 30 years of experience working with children and adults with developmental needs. As the Vice-Chairperson of one of our Boards of Visitors, Ms Sharifah used her expertise to provide valuable insights to Homes on how they can improve the care they provide to residents.
37. Volunteers, like Ms Sharifah, play a pivotal role in ensuring that good quality care is provided to residents.
a. Let me share an example from the Singapore Boys’ Hostel, a Children’s Home. The Board of Visitors had alerted the management team to feedback from residents on the lack of variety in meals. To address this, the Singapore Boys’ Hostel has engaged two caterers to provide greater variety in the food menu.
b. The close partnership between Homes, the Board of Visitors and MSF, ensures the residents’ voices are heard – a point that Mr Yip earlier alluded to with his suggestion for a separate Residents’ Bill of Rights to engender dignity, choice and respect for residents.
38. Under this Bill, MSF will be expanding the Board of Visitors to cover all these licensable Homes. I would like to call upon more interested individuals with the relevant experience and expertise to step forward as our volunteers, and join MSF in this journey of caring for the most vulnerable among us.
Conclusion
39. Mr Speaker, having addressed the comments and suggestions raised by the Members, I would now like to take this opportunity to put on record my deepest appreciation for the staff in our Homes.
a. Many of us may not be familiar with the work that these Homes do, and the residents that they care for. This is because the majority of our 4,000 residents live in the Homes 24/7. Today, I want to spotlight the dedication of staff in these Homes.
b. These 4,000 residents are cared for by about 2,000 staff – many of whom are care staff doing shift work to supervise and assist residents with their activities of daily living.
c. Social workers are another key group that play an important role in journeying with the resident through the challenges and milestones in life. Many of the residents have no one else in their lives to advocate for their needs and to ensure they have access to various resources and opportunities, except for these staff.
d. To be clear, the work that Home staff do is tough. It is not for the faint-hearted. But, it is extremely meaningful. Under their care, residents are given the help they need to facilitate their recovery, to preserve their health and cognitive functions, and be meaningfully engaged.
e. Residents with the potential to live independently, or return to their families, are also equipped with relevant independent living skills, such as personal care, household chores, budgeting, money management, social skills and help-seeking skills. This ensures that residents are set up for success, when they are reintegrated back into society.
i. I would like to share the story of Beatrice, a resident of Thuja Home at Pelangi Village. Beatrice was admitted into the Welfare Home in December 2019 with schizophrenia. Over the years, staff in Thuja Home worked closely with Beatrice in various areas and this includes regular check-ins, as well as referrals for psychoeducation and employment. With their care and guidance, Beatrice succeeded in securing employment. Today, she has secured a HDB rental flat and will soon be discharged from the Home.
f. To the staff in our Homes, thank you for all that you do. Your dedication to uplift the lives of those in need is the reason why residents like Beatrice can rebuild their lives, regain independence, and step into a future filled with hope.
40. Finally, I thank Members for your support for this Bill.
41. I believe this Bill is a much-needed step, as we strive to uphold the good quality of care provided to residents across the sector, and ensure that every single resident is kept safe and well in our Homes.
42. Thank you.